Amendment A003 to RFP 19LE2022R0002.pdf

Solicitation No. 19LE2022R0002 Page 2 of 5

SBU - CONTRACTING AND ACQUISITIONS

Continuation page of Block 14 of SF-30:

The purpose of this amendment to solicitation # 19LE2022R0002 is to correct:

A- B.1.1. – Excess Coverage reference should be corrected to C.1.1.21

B- Prices in Section B.2 will now read:

B.2.3 Base Year of

Contract

Bi-Weekly Rates Per

Premium

Category Estimated Number of Employees*

Rate per

Premium

Extended Bi-Weekly

Total

a. Employee 648

b. Spouse 421

c. Child 764

d. Subtotal

Total Price for Base

Year (d x 26)**

*estimated number of premiums does not include any Riders (B.1.1)

**does not include any premiums for Riders.

Rider Category*** Biweekly Rate per Premium

C.1.1.21 Excess Coverage

a. Employee

b. Spouse

c. Child

***not included in the Total Price for Base Year Calculation

B.2.4 First Option

Year of Contract

Category Estimated Number of

Employees*

Rate per

Premium

Extended Bi-Weekly

Total

a. Employee 648

b. Spouse 421

c. Child 764

d. Subtotal

Total Price for First

Option Year (d x

26)**

Solicitation No. 19LE2022R0002 Page 3 of 5

C.1.1.21 Excess Coverage

a. Employee

b. Spouse

***not included in the Total Price for First Option Year Calculation

B.2.5 Second Option

Bi-Weekly Rates

Per Premium

Rate per Premium Extended Bi-

Weekly Total

a. Employee 648

b. Spouse 421

c. Child 764

d. Subtotal

Total Price for

Second Option Year

(d x 26)**

a. Employee

b. Spouse

***not included in the Total Price for Second Option Year Calculation

B.2.6 Third Option

Bi-Weekly Rates

Per Premium

Rate per Premium Extended Bi-

Weekly Total

a. Employee 648

b. Spouse 421

c. Child 764

d. Subtotal

Total Price for Third

Solicitation No. 19LE2022R0002 Page 4 of 5

C.1.1.21 Excess Coverage

a. Employee

b. Spouse

***not included in the Total Price for Third Option Year Calculation

B.2.7 Fourth Option

Category Estimated Number of

Employees*

Rate per Premium Extended Bi-Weekly

Total

a. Employee 648

b. Spouse 421

c. Child 764

d. Subtotal

Total Price for Fourth

a. Employee

b. Spouse

***not included in the Total Price for Fourth Option Year Calculation

B.2.8. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years

Solicitation No. 19LE2022R0002 Page 5 of 5

C- The age bracket of 38 – 47 for females in Exhibit A is updated to read as follows:

1. EMPLOYEES BY GENDER WITHIN AGE RANGES

FEMALE MALE

Age (years) Number Age (years) Number

0-26 (1995 - 2021) - 0-26 (1995 -2021) 23

27-37 (1984 - 1994) 17 27-37 (1984 - 1994) 153

38-47 (1974 – 1983) 124 38-47 (1974 – 1983) 140

48-60 (1973 – 1961) 28 48-60 (1973 – 1961) 148

61-64 (1960 – 1957) 2 61-64 (1960 – 1957) 11

65-70 (1956 – 1951) 1 65-70 (1956 – 1951) 1

TOTAL 172 TOTAL 476

D- GR benefit, or Guaranteed Renewability benefit is requested under this solicitation, as mandated by local insurance law.

Attached documents:

1- Attachment A – Minutes from March 9, 2022 – Pre-proposal Conference

2- Attachment B – Questions and Answers

Attachment A

MINUTES OF MEETING

PRE-PROPOSAL CONFERENCE

DATE: 03-09-2022; 10:00-11:30 AM

SUBJECT: Pre-Proposal Conference for Health Insurance Solicitation (RFP # 19LE2022R0002)

PARTICIPANTS: Representatives from 7 Insurance Companies

Contracting Officer

Human Resources Office

Procurement and Contracting Office

The above-listed attendees met to discuss the solicitation package. The following were discussed:

1- CO welcomed all attendees and introduced the HR and GSO staff. She explained that the purpose of the meeting was to provide an opportunity for all firms to understand U.S. Government solicitation procedures, rules that apply to the solicitation process, and an overview of the Statement of Work (SOW). CO informed the participants that all documents will be posted on Sam.gov. No separate emails will be sent to bidders. Changes will be made in writing only. Anything said during the conference does not change the requirements of the solicitation. The embassy will be posting the answers to written questions received and those to be received during the pre-proposal conference on Sam.gov on March 18, 2022. The proposals due date will be amended to become on April 14, 2022. CO told the participants that as per FAR 4.1102, they should be registered in SAM at the time their offer or quotation is submitted. They need to abide by the Zadroga Act that entails 2% of the contract amount to be deducted and will not be paid to them. CO explained the NDAA requirements as well.

All participants were encouraged to ask questions at any time, and it was made clear to them that all questions and answers would be shared with all potential bidders.

2- HRO and HR Specialist provided a summary of Section C – Statement of Work, explained the requirements and what is expected from the offerors.

3- CO and Procurement Supervisor provided a summary of the solicitation package. Specific sections discussed were Section B- Prices, Section K- Representations, Section L- Instructions to Offerors and Section M-

Evaluation Factors. It was also explained that all necessary fields need to be completely filled out in SF-33, and

Sections B and K. Participant company representatives were reminded that failure to submit a complete proposal may be a cause for the proposal to be rejected and deemed as unacceptable. Bidders shall propose two prices:

one for Class A (private) and the second for Class B (semi-private). Separate price and technical proposals should be submitted by bidders.

4- It was also stated that the contract is going to be firm fixed price with economic price adjustment clause per

Section B. The contract is for one (1) base year and that the USG has the option for four (4) additional years and that offerors should prepare their proposals accordingly, filling out the forms in Part I of Section B in the solicitation document.

5- The criteria for the technical evaluation were explained. It was stated that the USG will determine the responsible offeror by evaluating the responses received from offerors for mandatory requirements for Health insurance coverage specified in section C.

6- In response to questions, CO told participants to submit their questions by March 11, 2022 in writing. All questions will be shared with everyone.

The Pre-Proposal Conference concluded and attendees were thanked for their presence and expression of interest in serving the U.S. Government. The meeting was adjourned at 11:30.

Attachment B

Questions and Answers

Here below the answers to the received questions:

Q1: GR feature is not mentioned in the tender, so it will be considered same as any Group within an insurance company in Lebanon followed by ICC regulation of 2018 (GRO

Provision Decree Nbr.186)

A1: Refer to Amendment # A003 to RFP # 19LE2022R0002.

Q2: Will the Coverage and Transportation outside Lebanon be granted to rider category

(ORE, EAE, Retirees)?

A2: Yes – participants covered under a rider are eligible for all the benefits stated in section C.

The retirees can elect from three (3) different options of the annual maximum limit, USD 125,000, USD 62,500 or USD 25,000. All other stated benefits are also applicable for the retirees. See C.1.4.3.c

Q3: Will the Excess Coverage ($125,000) be only available to LE Staff Employees and

Dependents (excluding category rider – ORE/EAE/Retirees)?

A3: Excess coverage will apply to a covered employee and to eligible dependents depending on the employee coverage. Once elected this will be applicable to the entire family. The excess coverage limit of USD 125,000 is per insured per contract year.

The Excess coverage is also an available option for the riders; namely ORE, EAE and the Retirees. Participants covered under a rider are eligible for all the benefits stated in section C.

Q4: Does the Annual Maximum Limit per Insured include all plans (IN, AMB, PM, DV, Dental, and Optical)?

A4: Refer to Section C.1.1 – Employee and Dependent Health Service Benefits.

Q5: How will the Financial Limitations be calculated by order for an Employee having the 3 limitations below:

1. Annual Maximum Limit of $125,000

2. Excess Coverage of $125,000

3. Catastrophic Coverage of $125,000

* HIV/AIDS have a special limit of 10,000$ outside of the 3 FL above

A5:

1. All the stated medical benefits listed in the scope of work under section C should fall under the annual maximum limit of USD 125,000.

2. Excess coverage is elective and comes as an addition to the annual maximum limit.

3. A catastrophic incident may trigger standard maximum coverage limit being exceeded. Catastrophic coverage provides a higher ceiling of coverage if a major medical event occurs. Note that the definition of catastrophic is written broad so as not to exclude anything that would be catastrophic. If insurance companies need to exclude anything, this needs to be made clear in the solicitation and the technical review panel would determine if the proposal is technically acceptable.

4. HIV/AIDS maximum limitation of USD 10,000 is outside the annual maximum limit, catastrophic coverage and excess coverage.

Q6: How will the Financial Limitations be calculated by order for retirees having the 2 limitations below:

1. Annual Maximum Limit ($125,000 or $62,500 or $25,000)

2. Catastrophic Coverage of $125,000

* HIV/AIDS have a special limit of $10,000 outside of the 2 FL above

A6: Same as A5 methodology.

Catastrophic coverage will be proportionate to annual maximum limit.

Q7: Coronavirus disease coverage was added under In-Patient to comply with ICC regulation of 2020 (Provision Decree Nbr.80)

A7: Coronavirus disease coverage is covered under this solicitation since it is not part of the Exclusions and limitations (C1.3). Coronavirus is an illness and should be treated as such with appropriate treatment and testing provided. The solicitation also includes diagnostic tests and immunizations at C.1.1.4.

Q8: Since no number of Transactions are specified for contractual period under Out-

Patient plans (AMB-PM-DV-Dental-Optical), should we add them Unlimited per

Insured?

A8: Yes. Refer to C.1.1

Q9: Dental & Optical plans will be covered on Reimbursement basis since no GlobeMed

Network is available.

A9: Yes, for dental and optical. All other stated benefits may be covered on reimbursement basis in case it is outside the network.

Q10: Will the Premiums be paid in Fresh US Dollars?

A10: Refer to G.3

Q11: There are 100 Employees missing from the Age Distribution by Gender (under LE

Staff), Section J – List of Exhibits / Attachments (Page 43)

A11: Refer to Amendment # A003 to RFP # 19LE2022R0002.

Q12: B.2.2 rate per premium should be per insured or per employee? Can we have table example and what is the meaning of extended total.

A12: Refer to Amendment # A0003 to RFP # 19LE2022R0002.

Q13: C1.1.1 are Private and semi-private mean class A and B?

A13: Yes, private and semi-private can be equated to local Class A and Class B coverage, respectively.

Q14: C1.1.16 Catastrophic coverage: Would this mean that an insured will have $125,000 coverage and additional $125,000 in case of catastrophic incident? If this is the case, then the coverage per insured is $250,000.

A14: Refer to A5 above.

Q15: A.1 employee statistics page 43 number of employees in the 1st table doesn’t match with the second table

A15: See A11

Q16: We already have a SAM account so could we use the same?

A16: In case the SAM account is still valid, the company can use it.

Q17: Reference to B.2. Prices – the pricing is based on categorization, which is Self, Self plus one, Family (3 or more individuals), we understand that pricing will be a flat amount per category.

If so, appreciate providing us with:

a- The list of insured including date of birth per category.

b- The amount of claims split by category.

A17: Refer to Exhibit A.1 for employee statistics and A.2 for claims experience

Exhibit B.1 for ORE statistics and B.2 for ORE’s claim experience

Exhibit C.1 for EAE statistics and C.2 for EAE’s claim experience

Exhibit D, E.1 for retirees’ statistics and E.2 for claims experience

Q18: Reference to page 6 of the RFP – Article “Minimum and Maximum Amounts” –

Need clarification.

A18: The United States Government (USG) will guarantee ordering the minimum amount referred to in Section B. The amount of all orders, for base and all option years shall not exceed the amount referred to in Section B. This reflects the contract maximum.

Q19: Reference to C.1.1.16 – Catastrophic Coverage – Is it a separate benefit at additional cost or incorporated as a benefit in the risk premium? Kindly advise.

A19: It is an additional coverage, the cost of which is incorporated in the premium.

Q20: Reference to C.1.1.21 – Excess Coverage

Appreciate providing with the following information:

a- Is it a new benefit or it’s an existing one b- if selected, is it compulsory to the whole family members?

c- Appreciate providing the list of insured benefiting from such coverage along with their date of birth and claims amount per year

A20: a- Yes, excess coverage is a new benefit.

b- Once the excess coverage is elected by the employee it will be applicable for the covered eligible family members.

c- Employees have not yet been notified of this new coverage. The list of insured who would like to benefit from this additional coverage will become available upon implementation of the contract.

Q21: Reference to C.1.4.3. – We understand that Retirees have the option to select one of the three plans listed in the article. Are these financial limits already implemented in the current contractual period? Please advise.

Appreciate providing us with a- The list of insured along with their date of birth per category.

b. The amount of claims split by category

A21: Two maximum limits options were provided for retirees during the current insurance contract: USD 120,000 and USD 60,000.

a- Refer to Exhibit D (E.1) b-Refer to Exhibit D (E.2)

Q22: Reference to A.2, E.2 and B.2 – Claims experience

Appreciate providing Claims amount split by benefit: Hospitalization, Ambulatory out-patient, Prescribed Medicines, Doctor Visits, Dental and Optical separately of base year and option years separately. Hospitalization and dental claims experience were provided in A.2, E.2 and B.2

A22: See below:

LE Staff Claims Experience

Average number of participants: 1850

Base Year August 13, 2017-August 12, 2018

Medicines Ambulatory Doctor Visits Optical

$316,341.57 $370,483.78 $198,016.19 $7,621.10

Option Year 1 August 13, 2018-August 12, 2019

$329,395.32 $404,820.68 $208,440.00 $5,246.51

Option Year 2 - August 13, 2019-August 12, 2020

$377,391.51 $363,090.67 $189,776.49 $7,628.53

Option Year 3 - August 13, 2020 -August 12, 2021

$391,933.46 $511,637.09 $267,347.45 $19,220.14

Option Year 4 - August 12, 2021 up to Feb 12, 2022

$443,937.17 $333,497.14 $262,408.17 $14,521.28

ORE - Claims Experience

Average number of ORE: 5

$645.85 $2,193.59 $1,247.74 $29.85

$627.54 $1,678.28 $653.73 $ -

$1,488.51 $1,790.40 $788.66

Option Year 3 - August 13, 2020 - August 12, 2021

$1,446.49 $2,827.89 $1,412.40 $ 216.00

Option Year 4 - August 12, 2021 up to Feb 2022

$146.24 $902.56 $957.13 $-

RETIREES - Claims Experience

Average number of Retirees: 14

$13,655.12 $6,360.29 $2,527.59 $871.64

$13,824.16 $8,085.57 $3,080.41

$11,805.14 $8,285.00 $1,766.87

$52,417.66 $10,233.21 $3,363.78 $85.97

Option Year 4 - August 12, 2021 up to February 12, 2022

$32,743.63 $11,863.95 $2,971.52 $-

BRASS - Claims Experience

Average number of BRASS employees: 35

$22,853.13 $14,157.35 $8,940.13 $333.44

$18,620.52 $12,385.21 $7,653.55 $364.65

$21,335.28 $9,047.81 $6,650.87 $41.79

$22,169.39 $24,175.94 $10,478.57 $ 475.75

Option Year 4 - August 12, 2021 up to Feb 12, 2022

$18,249.03 $7,529.86 $8,316.14 $36.00

Q23: Reference to A.2, E.2 and B.2 – Claims experience – Appreciate providing the total claims amount of Option Year 3 since it is for 9 months only

A23: See below. The claims experience provided was for the full year. The numbers did not change. Date updated to cover till August 12, 2021.

A.2

Option Year 3 - August 13, 2020 up to August 12, 2021

Hospitalization OUT-Patient Dental

$1,605,960.21 $1,190,138.16 $52,153.98

Total Premium Total Claims Loss Ratio

$4,357,059.83 $2,848,250.97 72%

B.2 (ORE)

Option Year 3 - August 13, 2020 up to August 12, 2021

Hospitalization OUT-Patient Dental

$5,715.76 $5,902.78 $ -

$18,001.04 $11,618.54 88%

C.2 EAE (BRASS)

Hospitalization OUT-Patient Dental

$ 30,409.15 $ 57,299.65 $ 1,855.25

$ 121,866.51 $ 89,564.05 82%

E.2 (RETIREES)

Hospitalization OUT-Patient Dental

$69,938.45 $66,100.61 $ -

Total Claims Loss Ratio

$136,039.06 135%

Q24: Reference to A.2, E.2 and B.2 – Claims experience Appreciate providing the claims amount of Option Year 4

A.24 Claims experience provided below for quarter 1 and 2 of option year four (4).

A.2

Option Year 4 - August 12, 2021 up to Feb 12, 2022

Hospitalization OUT-Patient Dental

$ 1,096,705.57 $ 1,054,363.76 $ 28,498.86

$ 2,179,568.19 $ 2,179,568.19 101%

B.2

Option Year 4 - August 12, 2021 up to February 12 2022

Hospitalization OUT-Patient Dental

$ 2,005.93 $ 143.28

$ 2,149.21 $ 2,149.21 26%

C.2

Option Year 4 - August 12, 2021 up to February 12, 2022

Hospitalization OUT-Patient Dental

$ 21,528.06 $ 34,131.02 $ 1,175.74

$ 56,834.82 $ 56,834.82 106%

E.2

Option Year 4 - August 12, 2021 -February 12, 2022

Hospitalization OUT-Patient Dental

$ 146,175.06 $ 47,579.11 $ -

Total Claims Loss Ratio

$ 193,754.17 384%

Q25: Would health insurance be mandatory or voluntary for the local staff members?

A25: Voluntary. However, we have 100% participation.

Q26: Confirm if the effort mentioned above considered as new requirement or are there incumbent contract(s)? If there is an incumbent vendor(s), would you be able to provide the contract details (such as: Vendor Name, Contract Number, Award and end dates, total contract value).

A26: There is an incumbent contract.

Current contract # SLE200-17-D-0004 - Health Insurance Services

Contractor: MetLife

Contract term: August 13, 2017 – August 12, 2022

Estimated Contract amount: $17.5 million for Five years

Please note that the current solicitation benefits and coverages are thoroughly different from the contract signed with Metlife Company almost five years ago.

Q27: Is this requirement currently performed by MetLife Insurance Company under

Contract #: SLE20017D0004 and is scheduled to expire on 08/12/2023, if all option periods are exercised? Are we missing any other active incumbent contracts? If so, may we ask for the contract details (such as: Vendor Name, Contract Number, Award and end dates, total contract value)

A27: Refer to A.26 above.

Q28: Is an estimated ceiling value available for this requirement?

A28: Yes. The Embassy has prepared an estimate for the new contract to be signed.

However, this information is for internal use only and cannot be divulged.

Q29: Please provide five years of loss data (table 1) by year of account including annual net premium (for the same period), incurred claims and membership history. For membership history (Table 2) please provide the number of Employees with single coverage and with family coverage at the end of each year. Please do not include any confidential information, just the overall statistics for the group. Claims information is critical to our pricing and the relationship of claims to employee growth or shrinkage is part of the claims analysis.

Table 1

Contractual year Total claims paid (local currency)

Retention amount

(local currency)

Total premium paid to

Insurer

(local currency)

Net gain

(local currency)

Net gain

USD or

EUR

dd/mm/2016 – dd/mm/2017 dd/mm/2017 – dd/mm/2018 dd/mm/2018 – dd/mm/2019 dd/mm/2019 – dd/mm/2020 dd/mm/2020 – dd/mm/2021

Table 2

Contractual year Single Self plus ONE Family plans dd/mm/2016 – dd/mm/2017 dd/mm/2017 – dd/mm/2018 dd/mm/2018 – dd/mm/2019 dd/mm/2019 – dd/mm/2020 dd/mm/2020 – dd/mm/2021

A29: Refer to Exhibits A, B, C, and D for details.

Claims experience provided are on Gross basis.

Q30: We would like to know if you have been informed of Catastrophic cases, such as: Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ

Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and

Chemotherapy), and hospitalizations with more than 10 days.

A30: Data for Base Year, Option year one, option year two, option year three, and the first

2 quarters of option year four:

For LE Staff: Injuries 57, maternity 202, cancer 134, heart 35, orthopedics 21

For EAE: Injuries 4, maternity 2, Heart 6, Orthopedics 1, cancer 2

For Retirees: Injuries 1, Cancer 7

Q31: What is the name if the insurance company that currently provides coverage?

A31: MetLife insurance company.

Q32: Is there a preferred list of Hospitals, Clinics or other Medical Facilities that the

Embassy employees prefer? If yes, please provide a list of these facilities

A32: There is no preferred network. The network of providers needs to cover all regions of Lebanon.

Q33: Could you please provide information about the claims you have had out of country during your current coverage?

A33: Zero claim for out of country coverage.

Q34: Has there been any changes to the Table of Benefits over the past 5 years?

A34: Reference: current Contract # SLE200-17-D-0004 covering the period from: August

13, 2017 – August 12, 2022.

Summary of the old table of benefits: Annual Maximum Limit is USD 300,000.

100% coverage for hospitalization. 100% coverage for obstetrical care.

90% coverage for out-patient services.

90% coverage for prescription drugs.

90% coverage for doctor visits up to a maximum of $60.

60% coverage for optical care.

45% coverage for dental care up to USD 345 per visit.

60% reimbursement for hearing aids.

50% coverage for psychiatric treatment.

100% coverage for physical therapy up to 20 visits per year per patient.

Medical expenses incurred out of country. Transportation for out of country treatment.

Q35: Would the Embassy accept proposals in USD where premium are also paid in USD from non US companies?

A35: Refer to A10.

Q36: Can also claims be paid in USD or is there a need to be paid in the local currency?

A36: It depends on the benefit.

Q37: Can proposals be submitted electronically or does the Embassy insist on hard copies?

A37: As mentioned in our Cover Letter of February 23, 2022, proposals should be submitted electronically. Only electronic submittals will be considered.

Q38: Would the Embassy accept a proposal form an internationally licensed insurance company under an offshore jurisdiction or does it insist on a locally licensed insurance company only?

A38: Refer to H.6.2

Q39: Would 2 % tax based on James Zadroga Act be applicable to this solicitation?

A39: Yes, refer to RFP # 19LE2022R0002 – B.1 Health Insurance Services.

Q40: Is this a mandatory plan, meaning all employees of the Embassy will be covered or voluntary, meaning the employees will be given the option to sign up for the health insurance?

A40: Refer to A25

Q41: What are the possible differences to the provided “Estimated Number of Premiums under a, b, c” as the number of insured persons is essential for the risk evaluation

(premium rates calculation)

A41: Refer to A12

Q42: Kindly provide the table of benefits.

A42: A detailed description of the benefits are outlined in section C of the RFP.

Q43: Kindly provide the census list:

1- Nationality

2- Date of Birth

3- Relationship (Employee/Spouse/child)

4- Country of residence

5- Gender

6- Marital status

A43: Refer to Exhibits A for employee statistics, Exhibit B for ORE statistics, Exhibit C for Employee Association, and Exhibit D for Retiree rider.

The country of residence of all insured employees is Lebanon.

Q44: Kindly provide detailed claims experience from incumbent insurer.

A44: Refer to Exhibits A, B, C, and D for claims experience.